Still struggling with BS levels...

[linda321]

Help! I am still struggling with high BS levels! After a couple of basal tests I decided that 19 units of Lantus taken in the morning is about right. But just these last few days I can't seem to get my BS any lower than 9, mostly between 10 and 12! I have a libre and since Saturday evening I have noticed that the rapid acting insulin doesn't seem to work.

For example, I usually inject 2 to 3 units of humalog before my breakfast of 1 boiled egg and 1 piece of Burgen toast (11g carb). Usually this will bring my BS down by a couple of units to a better level, somewhere between 5 and 9. Yesterday I woke with BS of 11.3, so took 3 units of Humalog before breakfast, but it had absolutely no effect and my BS rose to 15 by 11 o'clock. That was after a long walk with the dog, which I usually do every morning. Last night I exercised before dinner, and was 6.4 before dinner at 7pm, and it just kept rising to 11.4 by bedtime, despite injecting 3 units of Humalog (dinner was mince and veg, only carb was 1 small potato, and a satsuma - I reckon 15g carb in total.

When my basal was higher (25u) my BS did swing and spike a lot, and it is a lot flatter now.

What can I do? I am eating fairly low carb, 50 to 100g per day, I exercise a lot, 3 x per week at the gym and 2 dog walks per day. I am injecting at least 1 unit to 5g carbs. Could I be resistant to Humalog? Should I increase my basal again?

 

[noblehead]

Change your insulin cartridges to see if this helps @linda321

 

[novorapidboi26]

Keep testing the basal until its doing the job, or at least near enough there.....

how many mmoll is one unit of insulin dropping you by with regards your correction doses....?

 

[linda321]

Thanks Noblehead. I did think of that and changed my Humalog cartridge yesterday. I will be starting a new Lantus cartridge tomorrow anyway.

Thanks novorapidboi26. Yes I will keep doing the basal testing. I have done overnight tests, perhaps I should do them in the day too? I thought that was just for people on pumps? I am not sure exactly how correction doses work on me. I am assuming 1 unit of insulin drops me by about 2mmol, but I have no evidence for this! The graphs on my libre as so all over the place it's really difficult to say.

I really don't get this! And it is so frustrating me, beginning to think that I am stressing myself out and that is what is raising my BS!

 

[dylt1]

Thanks Noblehead. I did think of that and changed my Humalog cartridge yesterday. I will be starting a new Lantus cartridge tomorrow anyway.

Thanks novorapidboi26. Yes I will keep doing the basal testing. I have done overnight tests, perhaps I should do them in the day too? I thought that was just for people on pumps? I am not sure exactly how correction doses work on me. I am assuming 1 unit of insulin drops me by about 2mmol, but I have no evidence for this! The graphs on my libre as so all over the place it's really difficult to say.

I really don't get this! And it is so frustrating me, beginning to think that I am stressing myself out and that is what is raising my BS!

Hi Linda,

Have you tried a different injection site? If you say you have no evidence why don't you try it? Wait till your flat and inject yourself with one unit of fast acting and see how much you go down by.

 

[linda321]

Thanks dylt1! I hadn't thought of that. I'll give it a go.

Could it be the cold weather affecting the absorption of Humalog? Today is no better, woke with BS of 5.2, had 11g carb breakfast so injected 2units. Went up to 11.7 by lunchtime. Had 20g carb for lunch,injected 4units and have gone up to 16.7 1.5 hours later. I would have thought my lunchtime bolus would have kicked in by now!

 

[noblehead]

Thanks dylt1! I hadn't thought of that. I'll give it a go.

Could it be the cold weather affecting the absorption of Humalog? Today is no better, woke with BS of 5.2, had 11g carb breakfast so injected 2units. Went up to 11.7 by lunchtime. Had 20g carb for lunch,injected 4units and have gone up to 16.7 1.5 hours later. I would have thought my lunchtime bolus would have kicked in by now!

You really need to do the basal tests @linda321 to see why your bg is climbing so high, when you do make sure it's a fasting test so don't eat any food (whether it has carbs or not).

 

[jrussell88]

I second noblehead's advice re basal tests.

You need to simplify things to see what's going on - make one change at a time. Check your overnight profile first - ideally it should be flat or rising slightly to avoid overnight hypos. Run a fasting day to check your daytime profile.

Adjust your basal to get the overnight right first, then deal with the daytime. Perhaps it's on a rising trend? If your overnight profile is good, you may need to take extra corrections during the day.

Bear in mind that the increase in your metabolism as you wake up puts your blood glucose on a rising trend, which may require an extra unit or two to cover it when you wake, in addition to your breakfast dose.

You may also find that corrections when your blood glucose is higher have less effect than within the normal range.

Some people find their sensitivity to insulin changes during the day; as you've got the Libre you can use it to measure the effects of insulin and food.

 

[steve_p6]

Agree with both of prev posts, not clear how u did your basal tests. This is the most commonly posted link for basal testing http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007

 

[linda321]

Thanks! That makes sense.

I did a basal test last night and I went from 11.4 at bedtime to 3.4 when I woke up! Obviously my basal is too high,so I have lowered it by 2units. I can't do another one tonight, as I go to the gym and eat late on Thursdays. I'll continue over the weekend.

 

[tim2000s]

Thanks! That makes sense.

I did a basal test last night and I went from 11.4 at bedtime to 3.4 when I woke up! Obviously my basal is too high,so I have lowered it by 2units. I can't do another one tonight, as I go to the gym and eat late on Thursdays. I'll continue over the weekend.

Hi Linda, I see you are a Lantus user. Consultants now recommend using a split dose basal with Levemir if you are a regular gym user (especially if you go in the evenings) as it allows more flexibility in the basal dose, which isn't there with Lantus.

It is worth doing a basal check after you've been to the gym (even though you would normally eat late) - maybe consume a decaf bulletproof coffee for satiety. Many people find that they have a different basal requirement post gym than on a non-gym night. To give you an example, on MDI, my gym days I took an overnight basal of 6u whereas on a non-gym day it was 8u.

Given your activity levels, you may very well need to take this approach rather than a single daily Lantus dose.

 

[LucySW]

And also, Linda, just a general word. As you have the Libre and thus all the data, you will eventually be able to work it out. So don't lose hope - record all your insulin doses, meals and carb content, and look at the totality of the numbers, perhaps not every day. It will really get you down otherwise.

I wd expect basal twice a day to work better. And I would calibrate the basal to keep you flattish most of the night, but not to cope with Dawn Phenomenon. For that I'd take a correction dose, first thing in the morning.

Obviously my circs are quite different as I'm in my LADA honeymoon on low doses, but that's what I do myself, and it works much better than increasing night time basal and then going low.

It really does sound, tho, as if this basal regime is not suiting you at all.

 

[denbo]

As anyone else ad this problem been on inslin since 2008 humalog 25 mix now this past week my BS av been really high the diabetic nurse as sed might av to change the insulin so been the docs today and got to refer me as not under the hospital anymore so bk agen I av to go hopin it's not too long before I hear off em asnt head feels ozzy most days

 

[azure]

Could you be coming down with an illness or infection @denbo ?

Have you tried changing your insulin pen/cartridge/vial just in case the insulin has gone off and isn't as effective? That can happen sometimes.

 

[denbo]

No no infection or illness and I've just started a new cartridge my doc as emailed the diabetic team so I'm thinking got to b a change ov insulin so just waitin now for them to send for me hopin it not goin to b long as can't keep feelin like I am thanx anyway

 

[RuthW]

What is the timing of your bolus and meal? Are you leaving long enough between the bolus and actually eating? That is the probable cause, if your basal is right.